Request

I would like to know if there are audits undertaken on the uptake of Serious Shortage Protocols (SSPs), or if not, if there is data you could give me that would allow me to do my own audit on them.

We’ve been talking about SSPs in the Community Pharmacy Patient Safety Group, and now that we have had a lot of SSPs in place, and some have been quite complex, we’re getting feedback about (a) some pharmacy teams opting not to follow them because they’re too complicated or they don’t have time, and (b) some dispensing errors that have been caused by following an SSP incorrectly.

(1) To that end, do you have data from any audits about how widespread SSP usage is? That is, how many pharmacies could have followed an SSP, but chose not to (or the patient chose not to)?

I know there is no easy way to figure that out (a patient might not want the SSP alternative, and we wouldn’t know if the lack of SSP usage was because of the patient’s choice or the pharmacist’s workload), but perhaps we could approximate: for example,

(2) How many SSP-eligible drugs are dispensed (or are on the spine as “owing”) without the SSP having been followed (which can be approximated by: was the SSP endorsement used)?

Response

A copy of the information is attached.

NHS Prescription Services process prescriptions for Pharmacy Contractors, Appliance Contractors, Dispensing Doctors and Personal Administration with information then used to make payments to pharmacists and appliance contractors in England for prescriptions dispensed in primary care settings (other arrangements are in place for making payments to Dispensing Doctors and Personal Administration). This involves processing over 1 billion prescription items and payments totalling over £9 billion each year. The information gathered from this process is then used to provide information on costs and trends in prescribing in England and Wales to over 25,000 registered NHS and Department of Health and Social Care users.

Data Source

The data source was the NHSBSA Information Services Data Warehouse.

The Data excludes: • Items not dispensed, disallowed and those returned to the contractor for further clarification. • Prescriptions prescribed and dispensed in Prisons, Hospitals and Private prescriptions. • Items prescribed but not presented for dispensing or not submitted to NHS Prescription Services by the dispenser.

Time Period

Monthly data from October 2019 to January 2023

Organisation Data

The data provided is for prescriptions dispensed by English Pharmacy Contractors.

BNF Code

The BNF Code is a 15 digit code in which the first seven digits are allocated according to the categories in the BNF and the last 8 digits represent the medicinal product, form, strength and the link to the generic equivalent product. NHS Prescription Services has created pseudo BNF chapters, which are not published, for items not included in BNF chapters 1 to 15. The majority of such items are dressings and appliances which NHS Prescription Services has classified into four pseudo BNF chapters (20 to 23).

Items

Items shows the number of times a product appears on a prescription form not the quantity prescribed.

Total Quantity

Total quantity is the number of items multiplied by the quantity prescribed. e.g. 2 items prescribed, one with a quantity of 2 and one with a quantity of 3, the total quantity would show as 5 (1 item x quantity of 2) + (1 item x quantity of 3)

Dispensers

The count of unique pharmacy codes in each month for each presentation. Note that pharmacies will be counted against multiple months and presentations so to avoid double counting these numbers should not be aggregated to any level other than that provided.

SSP Endorsement

The NHSBSA does not hold information in our database of which prescription items were eligible for SSPs. Reporting was produced for all drugs for a selection of BNF chemical substances. These chemicals were chosen based on whether a SSP was granted for any presentation under the chemical in any month included in the request. This means that for a large proportion of the data provided, no SSP would have been eligible.

BNF Chemical Substances included are listed below.

 0403030E0  Fluoxetine hydrochloride
 0402010J0  Haloperidol
 0105010E0  Sulfasalazine
 0602010V0  Levothyroxine sodium
 0601023W0  Metformin hydrochloride/pioglitazone
 0604011G0  Estradiol
 0212000B0  Atorvastatin
 0407010H0  Paracetamol
 0604011Q0  Oestrogens conjugated with progestogen
 0702010F0  Estriol
 0302000N0  Fluticasone propionate (Inhalation)
 0501011P0  Phenoxymethylpenicillin (Penicillin V)

The data has been split further by whether an SSP endorsement was held against the prescription item or not. Dispensers may be counted in both the with and without endorsement figures so to avoid double counting the figures for dispensers should not be aggregated to any level other than that provided.

Please note while data has been provided monthly SSPs are active for varying time periods including partial months. i.e. not all prescribing in a month may have been eligible.

Note that there is no record of which SSP each item was claimed against. A list of SSPs can be found on the NHSBSA website at https://www.nhsbsa.nhs.uk/pharmacies-gp-practices-and-appliance-contractors/serious-shortage-protocols-ssps

Please note that this request and our response is published on our Freedom of Information disclosure log at:

https://opendata.nhsbsa.net/dataset/foi-01055